Yokose Masashi, Hirosawa Takanobu, Tsunashima Keita, Shimizu Taro
Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Mibu, JPN.
Department of Emergency and General Medicine, Dokkyo Medical University Nikko Medical Center, Nikko, JPN.
Cureus. 2024 Jul 25;16(7):e65325. doi: 10.7759/cureus.65325. eCollection 2024 Jul.
Recognizing typical presentations of atypical cases is essential to reduce diagnostic errors and achieve better diagnoses. To better understand this, we report a typical case of "three noes" infective endocarditis (no left-sided, no intravenous drug use, and no intracardiac devices) with some different characteristics from well-known infective endocarditis. A 16-year-old boy with a history of atopic dermatitis presented with a one-month history of intermittent fever and shaking chills. The patient became afebrile with oral antibiotics, and initial investigations did not detect any evidence of bacterial infection, including heart murmurs and peripheral embolic manifestations. However, his symptoms relapsed one week after the cessation of antibiotics. A repeated workup revealed tricuspid valve infective endocarditis due to methicillin-susceptible . The relationship between atopic dermatitis and infective dermatitis has been reported in some literature, and clinicians should consider three noes infective endocarditis in patients with atopic dermatitis presenting with fever and unremarkable physical examination.
认识非典型病例的典型表现对于减少诊断错误和实现更好的诊断至关重要。为了更好地理解这一点，我们报告一例典型的“三无”感染性心内膜炎病例（无左侧病变、无静脉药物使用史、无心脏内装置），其具有一些与知名感染性心内膜炎不同的特征。一名有特应性皮炎病史的16岁男孩，有1个月间歇性发热和寒战病史。患者口服抗生素后体温恢复正常，初步检查未发现任何细菌感染证据，包括心脏杂音和外周栓塞表现。然而，抗生素停用1周后症状复发。再次检查发现由对甲氧西林敏感的……引起的三尖瓣感染性心内膜炎。一些文献报道了特应性皮炎与感染性心内膜炎之间的关系，临床医生对于出现发热且体格检查无明显异常的特应性皮炎患者应考虑“三无”感染性心内膜炎。
